A retrospective cohort study on the association between antipsychotics prior to and in the emergency department and their longer‐term impacts in older adults with acute agitation

BACKGROUND: Increasing prevalences of dementia are resulting in more presentations of older patients with agitation to the emergency department (ED). Antipsychotics are used for symptom management but increase the risk of sedation, falls and cognitive impairment. OBJECTIVE: This study aims to determine whether antipsychotics in older adults with acute agitation in emergency settings is associated with adverse hospital-related outcomes and longer-term mortality. METHOD: We conducted a single-centre, retrospective cohort study of patients aged >65 years presenting to the ED with acute agitation over a 6-month period. Exposure to antipsychotics in and prior to ED, hospital length of stay (LOS) and hospital-acquired complications (HACs) were assessed. RESULTS: Of 138 presentations, 63 received antipsychotics. The average age of participants was 81 years, with 52% being male. Median ED LOS was longer in participants who received antipsychotics 8.31 h vs 5.45 h in those who did not (P = 0.001). Similarly, median in-hospital LOS in participants who received antipsychotics was longer at 5.00 days vs 0.56 days (P = 0.005). The incidence of HACs (49.2% vs 14.7%, P < 0.001) and in-hospital mortality (15.9% vs 4.0%, P = 0.013) was higher in participants who received antipsychotics. Patients given antipsychotics were more likely to be discharged with new or higher doses of antipsychotics 23.8% vs 4.0% (P = 0.001). Mortality at 6 and 12 months was not different between the two groups (P = 0.512 and 0.204 respectively). CONCLUSION: Emergent antipsychotic use is associated with increased LOS, HACs and hospital mortality. These patients are also more likely to be discharged with new antipsychotics.